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Application Number: APP-34591 PRMIT NO. E DANE COUNTY ZONING PERMIT Page 1 oft ZONING 0ERMI OWNER INFORMATION I AGENT/CONTRACTOR INFORMATION OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE LUBY LIVING TR, TIMOTHY J (630)653-6006 PATRICIA MICETIC (608)877-0788 BILLING ADDRESS (Number,Street) ADDRESS (Number,Street) 312 ELLIS AVE 219 E. TAFT ST. (City,State,Zip) (City,State,Zip) WHEATON, IL 60187 STOUGHTON, WI 53889 E-MAIL ADDRESS E-MAIL ADDRESS TIMLUBY @AOL.COM PDMARCH @AOL.COM PARCEL NO. TOWNSHIP SECTION 1/4 '/4 1/4 0611-191-4990-0 PLEASANT SPRINGS 19 NE SW -J:feliJI l Wff.1111]:44*211 HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE (Assignment of new address is subject 2299 WILLIAMS POINT DR to field verification.) LOT BLOCK C.S.M.NO.2►PLAT NAME 40 PLAT: WILLIAM'S POINT- ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: ❑New S.ti Addition/Alteration CENSUS CODE R-3 0.28 Description:ADDNS/ALTNS TO 1ST&2ND FLRS-SFR 434 - RES ADD CATEGORY Residential ❑Commercial ❑Agricultural SEWER SANITARY PERMIT NO. Other: {y Public ❑Private ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION E -- 3556 ❑Yes t\lo SHORELAND FLOOD ZONE WETLAND EC/SW NO. o Yes ❑No ❑Yes No ❑Yes No U ! —0(D(De; HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET 29.75 0 467 2248 Sq.Ft. Sq.Ft. PROJECT COST NO.OF STORIES 2nd FLOOR 3rd FLOOR $ 150,000.00 2 1781 0 PERMIT FEE Sq.Ft. Sq.Ft. $ 219.00 1. I,the undersigned,hereby make application for a zoning permit only for the location and the work described herein and certify to the accuracy of that information. I further certify I am the owner of the property, or a duly authorized representative,and may sign this permit application on behalf of the owner(s) of said property, and I have read and understand all of the conditions of this permit and will construct the project in compliance with those conditions. I understand that failure to comply with any provision of the permit renders it null and void and may result in an enforcement action. 2. I,the undersigned,hereby certify that: • I have made a diligent inquiry into the applicability of any official map to the applicants'land; • No such official map is applicable,or,if such map is applicable,the approval of the appropriate city or village has been obtained; • I have not relied upon any statements of County employees in giving these assurances; • I understand the possible adverse consequences of erecting any structure within an officially mapped area without the proper approval of the city or village involved.Any zoning permit issued for a property located within an official mapped area for which the applicant has not obtained the proper permit from the appropriate village or city shall be null and void. 3. I, the undersigned, hereby consent to the entry on the permitted premises by zoning inspectors of the Dane County Department of Planning & Development to determine compliance with the county's zoning ordinances.This consent is valid for the period commencing with issuance of this zoning permit and terminating with issuance of a certificate of compliance or until earlier revoked in writing by the owner of the property. Owner&Agent hereby agree to comply with all Dane County SIGNATURE: Owner/Agent . DATE: Ordinances.Any unauthorized change from the information 1 • or plans submitted will invalidate the permit I Li 4- o 7 OFFICE USE ONLY SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSP C LION ATE INITIALS, Yes ❑No 04 Jun 2009 KLS i1 C, L�� 1 S 1. DATE REVIEWED INITIALS 2nd INSP CTI(fi¢1NN ATE ` INITJ[�4S Initials: 1 0 (,( I0 $1 rZ ( Conditions: 1.THIS APPROVAL BY DANE COUNTY ZONING IS ONLY FOR THE PLAN AS PRESEN ED. ANY MODIFICATION TO THE PROJECT REQUIRES THE EXPRESS WRITTEN APPROVAL BY DANE COUNTY ZONING. THIS PERMIT SHALL BE NULL AND VOID IF ANY MODIFICATIONS ARE MADE WITHOUT THE EXPRESS WRITTEN APPROVAL OF DANE COUNTY ZONING.INITIALS 2 ROSS ' ONTRO . .OW' ER/AG 'f MUST r ONT• . HE D, NE COU -I'113EPA TMENT OF AN, : WA'ER -- OURC:S(61,; 24-3647)To H: . IT DETER IN es AN EROSI N C OL P 'MIT IS ' ! IRED. 545-112(12/05) GCS-multi